Cesarean Section PDF

C-Section
Introduction
A Cesarean section, or C-section, is the surgical delivery of a baby through an incision
in the abdomen.
About 1 out of 4 women in the United States deliver their babies via C-sections. That is
around a million deliveries a year!
This reference summary is about C-sections. It discusses why they are needed, how
they are performed, the risks and what to expect after the procedure. If your doctor
recommends C-section, the decision to have this procedure is also yours.
Anatomy
In order to understand C-sections, it is important to know about the female
reproductive organs. They are located in the pelvis, between the urinary bladder and
the rectum.
The female reproductive organs include:
1. The vagina
2. The cervix
3. The uterus
4. The Fallopian tubes
5. The ovaries
When an ovary releases an egg, the egg goes down
the Fallopian tube to the uterus. It can become
fertilized along the way.
If a woman gets pregnant, the fetus stays in the
uterus until delivery. The uterus is able to expand a lot.
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This document is for informational purposes and is not intended to be a substitute for the advice of a doctor or healthcare professional or a
recommendation for any particular treatment plan. Like any printed material, it may become out of date over time. It is important that you rely on the
advice of a doctor or a healthcare professional for your specific condition.
1995-2012, The Patient Education Institute, Inc. www.X-Plain.com
Last reviewed: 07/07/2012
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The lowest part of the uterus is called the cervix. It opens into the vagina, which opens
to the outside of the body between the urethra (the urinary bladder opening) and the
rectum.
Pregnancy
During pregnancy, the baby floats in a special fluid called amniotic fluid. Both the baby
and amniotic fluid are in a bag called the amniotic sac.
The baby gets nutrition from the placenta. During
pregnancy, the placenta grows and attaches to the
inside of the uterus.
Placenta
The mothers blood enters the placenta and delivers

oxygen and nutrients to the babys blood. The
mothers blood also picks up waste from the babys
blood.
The babys blood travels from the babys body to the
placenta through the umbilical cord. The mothers
blood does NOT go into the babys body.
When it is almost time to deliver the baby, the babys head drops down into the
mothers pelvis. This causes the mothers belly to appear slightly smaller. This is called
lightening.
Labor
Labor starts when the mother feels cramps in
her abdomen. These are contractions of the
uterus muscles.
Sometimes the amniotic sac opens before the
actual delivery and amniotic fluid seeps out
through the vagina. When this happens, we say
the water broke. Labor can start when the
water breaks.
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There are 3 stages of labor:

1. Dilation and effacement stage
2. Baby delivery stage
3. Placenta delivery stage
During the dilation and effacement stage, the cervix slowly becomes 10 cm wide. This
is called dilation. The cervix also becomes thinner which is called effacement. The
mother is only asked to push when the uterus is fully effaced and dilated.
When the cervix is 10 cm wide, the baby delivery stage starts. This is when the baby
moves through the cervix and vagina to the outside world! The path the baby travels
through is called the birth canal. This is when the mother is asked to push during
contractions.
After the baby is delivered, the placenta delivery stage starts. This is when the
placenta is delivered.
Indications
A doctor performs a Cesarean section if he or she thinks it is safer for the mother or
her baby than vaginal birth. Most C-sections are done if unexpected problems happen
during labor.
The most common reasons for a C-section are:
1. The baby is not tolerating labor
2. The baby is not in the right position
3. There is not enough room for the baby to go through the vagina
4. The cervix does not dilate completely
5. There are medical emergencies
The baby is monitored during labor. The baby may show signs that
he or she may not be tolerating the stress of labor. This could
happen if the umbilical cord is pinched or if the placenta stops
working.
For normal vaginal delivery, the babys head comes out first. If the
baby is positioned so its buttocks or feet will come out before its
head it is called a breech position.
Breech Position
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A breech position can make vaginal delivery impossible, requiring a C-section. Breech
position is more likely with twins or triplets.
The babys head might be too large or the mothers birth canal too small to allow for
safe vaginal delivery.
Sometimes the cervix does not completely dilate to 10 cm. The baby may not have
enough room to pass through the birth canal. Long labor is very exhausting and risky
for the mother and baby. The doctor may try other solutions to dilate the cervix, but if
these fail a C-section might be the recommended option.
There are medical emergencies that make a C-section
necessary. For instance, the placenta could break away
from the uterus before delivery. This is called placenta
abruptio. Another medical emergency is if the umbilical
cord comes out before the baby during labor.
Sometimes the doctor knows ahead of time that a Csection is best. For example, if a woman has had a Csection before, the doctor may recommend it for her next
baby. However, it is possible for a woman to give vaginal
birth even if she has had a
C-section before.
Sometimes the placenta is too low in the uterus and it covers the cervix. This is called
placenta previa. In this case, the placenta blocks the birth canal and vaginal delivery
would be very risky. Usually the doctor can tell if there is placenta previa from
ultrasounds weeks before the delivery.
If the mother has a medical condition such as diabetes, heart disease, lung disease or
infectious diseases of the genital area the doctor may suggest a C-section.
The doctor could suggest a C-section for various reasons. However, in some of these
cases, a normal vaginal delivery might still be possible.
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Procedure
A C-section takes place in an operating room. If the mother is
in the delivery room when a C-section is needed, she is
moved to the operating room.
The anesthesiologist gives the mother anesthesia. Regional
anesthesia is usually used but general anesthesia is
sometimes needed. For general anesthesia the mother is
asleep and cannot see, feel, hear or remember the surgery.
Regional anesthesia can be given through an epidural or a
spinal block. If the mother has regional anesthesia, she may
still be able to feel the baby being pulled out but she will not
feel pain.
With epidural anesthesia, a needle or catheter delivers pain medication near the spinal
cord. The mother can still feel the pushing but has much less pain. If needed, more
medication can be given through the needle or catheter to provide pain relief.
For a spinal block, a needle or catheter delivers medication into the fluid-filled space
surrounding the spinal cord. The mother does not feel any pain in the abdomen or
legs.
After anesthesia, the doctor makes 2 incisions. The first incision is through the skin
and abdominal wall. The second one is through the uterus.
The incision through the abdominal wall is about 6 inches long.
The incision goes through the skin, fat and muscles. It does not
go through the peritoneum, the lining around the intestines and
other digestive organs. This incision can be vertical or
horizontal.
If the incision is horizontal it is called a bikini incision. It is made
across the lower abdomen, near the pubic hairline. Bikini
incisions are used in most C-sections because they usually
heal well and can cause less discomfort after surgery.
Bikini Incision
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Vertical incisions start just below the navel and go to just above the pubic bone. When
a large, fast incision is needed so the baby can be removed quickly, a vertical incision
is used. The doctor usually decides the type of incision.
After making the abdominal incision the doctor opens the uterus. There are several
factors that determine the type of uterine incision. These include position of the baby
and urgency of delivery. The 3 common uterine incisions are:
Low horizontal incision
High vertical incision
Low vertical incision
Low horizontal incisions are the most common. They go across the lower part of the
uterus. They usually bleed less than incisions made higher on the uterus. Low
horizontal incisions form strong scars, which result in less risk of the incision breaking
open if the woman has more babies.
High vertical incisions used to be used for all C-sections. Now it is only used in
emergencies because it has the highest risk of bleeding. There is also more risk of this
type of incision breaking open if the woman is ever in labor
again.
Low vertical incisions are like high vertical incisions, but lower
on the uterus. A low vertical incision helps deliver babies who
are in an awkward position in the uterus.
After the baby is removed from the uterus, the doctor clamps
and cuts the umbilical cord.
While the nurses clean the baby, the doctor removes the
placenta from the uterus.
Finally, the doctor closes each incision. Internal stitches
dissolve and do not need to be taken out. Stitches on the
outside may be dissolving stitches or staples that have to be
taken out.
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Risks & Complications

A C-section is a very safe procedure. However, it is a major
surgery. Like any surgery it has risks and complications.
Knowing about them may help you prevent or detect
complications early if they happen.
There are two different types of anesthesia that could be used:
general and regional. Regional anesthesia could be
administered either through an epidural or spinal block. Its risks
include nausea, vomiting, urinary retention, cut lips, chipped
teeth, sore throat, and headache. More serious and rare risks of
anesthesia include heart attacks, paralysis, severe spinal
headaches, strokes, pneumonia, and death.
These risks are very rare and are specific to the type of anesthesia used. Make sure to
check with your anesthesiologist or nurse anesthetist about the type of anesthesia that
will be used and its specific risks and complications.
Risks and complications related to any surgical procedure include
Infection
Bleeding
Scarring
Infections could occur on the skin or deep in the abdomen and pelvis. Antibiotics and
sometimes surgery are needed to clear up infections.
If there is a lot of bleeding, sometimes a blood transfusion is needed after a C-section.
Scarring may occur. It is rare for the outer scar of a C-section to
be unsightly. However, internal and external scarring may be
painful.
There is a risk that organs near the uterus could be injured
during a C-section. This might require another operation to fix
the possible damage.
After healing, a uterine incision could leave a weak spot in the
uterine wall. This might cause problems if the woman tries to
deliver another baby vaginally.
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Rarely, the bowel slows down for several days after surgery, resulting in distention,
bloating and discomfort. This is called ileus.
A babys lungs are normally filled with fluid before birth. When a baby is born vaginally,
movement through the birth canal naturally squeezes the babys chest and pushes the
fluid out of the lungs. During a C-section, the baby does not experience that squeezing
effect, so his or her lungs may still be wet after birth.
The main risk for the baby is a mild respiratory difficulty called transient tachypnea.
This rapid breathing occurs when the babys lungs are too wet. The doctors and
nurses can give the baby extra oxygen. They may use oxygen under pressure to force
fluid out of the babys lungs. Transient tachypnea typically goes away within a few
hours or days.
The baby may be less likely to be breastfed because of the difficulty of caring for the
baby while recovering from surgery.
After a C-Section
The hospital stay after a C-section is 3 to 4 days. It is a little longer than the 1 or 2 day
stay for vaginal delivery. Recovering after a C-section takes longer, too.
After a C-section, the mother might need pain medicine for a few days. She will also
feel weak or tired. It is important for her to walk. This helps prevent blood clots in the
veins of the legs and pelvis. It also prevents fluid buildup in the lungs.
It is normal for a woman to feel blue after a delivery, whether it was vaginal or
Cesarean. Those feelings usually go away. Even so, it is important to tell the doctor
about them. He or she may recommend a support group or prescribe medication.
Conclusion
A C-section is the surgical delivery of a baby through an incision in the abdomen. It is
a common procedure, used for about one million deliveries every year in the United
States.
Most C-sections are done when unexpected problems happen during labor, such as:
The baby is not tolerating labor
The baby is not in the proper position
There is not enough room for the baby to go through the vagina
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There are emergency problems with the placenta

The cervix does not dilate completely
A C-section is a relatively safe procedure for the mother and
baby. However, it is a major surgery. Like any surgery it has
risks and complications that include infection, bleeding, and
scarring.
After healing, a uterine incision may leave a weak spot in the
uterine wall. This could cause problems with future attempts at
vaginal birth.
A long time ago, childbirth was very risky for the mother and the
baby. Thanks to advances in medical technology, C-section is
now a very safe procedure that saves millions of lives every
year.
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C-Section

The mothers blood enters the placenta and delivers

There are 3 stages of labor:

Risks & Complications

There are emergency problems with the placenta

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